by Elizabeth C.
I was given the privilege of working with a friend’s 12-year-old son a month or so into clinic, at a point in the program in which my confidence was building but still relatively fragile. Meaning, I felt self-assured when presented with a client suffering from a sore neck or in the late recovery stage of an injury, even surgery. This, however, felt like a very different challenge. My client, who I soon discovered is incredibly sweet, curious, intelligent and surrounded by a rockstar family for support, also has quadriplegic Cerebral Palsy.
From my initial intake with this young man, I learned that his language was limited but his comprehension was highly functioning. His movements were abrupt and writhing, requiring aid to walk, undress and get on the massage table. Once on the table, the involuntary muscle shaking or possible intention tremors continued. His muscles were very tight with aspects appearing as restrictive contractors which pulled on the skeleton of his hands and wrists, as well as chest and spine, resulting in the appearance of some possible curvature of the spine or otherwise imbalances along the spinal musculature. I noticed that many of his muscles had a hypertonic quality which is common for people with cerebral palsy due to damage in the cerebrum and basal ganglia, responsible for motor function.
I began the session with the client lying prone, hoping that working on his back first might activate his parasympathetic nervous system encouraging relaxation and deeper, fuller breath. Additionally, I remembered that many people with cerebral palsy suffer from digestive issues and thought that by activating his parasympathetic nervous system it may encourage motility in his gastrointestinal tract seeing as the parasympathetic nervous system is responsible for “rest and digest”. As I worked on his back body, the writhing and shaking movements continued although I noticed slightly deeper breath. In addition to working on his back, I worked quite a bit on his gastrocnemius and Achille’s tendon, realizing that the musculature was extremely hypertonic due to his limitations with walking independently. After my client turned to lie on his back, I focused the work on his arms and hands. The joints in these limbs felt very constricted with a clasp-knife effect in his hands resulting in flexion of the wrists and metacarpals that was difficult and, in some areas, impossible to bring into extension. While there was not any visible or tactile change in the muscle quality, I hope that this work provided some temporary relief from discomfort and pain.
After more research and through my continued studies at massage school, there are several additions that I would make to the protocol to create a beneficial treatment for this client. First, I would incorporate some simple stretching and joint mobility on all of his limbs but with a focus on his legs and feet to improve circulation and synovial health. I know how beneficial simple stretching techniques can be for someone with a healthy range of motion so I can only imagine the benefits and relief they might provide for someone unable to stretch on their own.
In class recently, I learned Shiatsu techniques and the benefits of stimulating energetic flow through rhythmic and gentle rocking and compression. With this new information, I believe that integrating these techniques into my client’s session may help to further initiate and activate a parasympathetic response. I would integrate palm rocking and compression techniques to access the muscles in a way that can help alleviate chronic pain and to help shift the muscles out of their habitual constriction. I have noticed through practicing and receiving Shiatsu, that the repetitive and rhythmic quality of rocking can release muscle groups in far less invasive and direct ways than some other modalities such as deep tissue. There is a time and a place for all massage techniques, and it seems to me that the cradling effect of Shiatsu would be highly beneficial for someone experiencing severe muscle constriction and lack of muscular control.
Finally, with my client’s permission, I would place a more direct emphasis on the abdomen, applying effleurage and petrissage techniques to help with any potential issues or blockages in the gastrointestinal tract. I would be sure to work with relatively light pressure and rhythmic consistency to mimic some of the rocking techniques from the integrated Shiatsu. While this work can sometimes feel vulnerable, from personal experience, I have found it can provide a lot of digestive relief as well as have a profound effect on the nervous system, eliciting relaxation.
Working with this young man reminded me of my experiences in high school participating in Best Buddies, an organization that creates opportunities for friendship between people with developmental and intellectual disabilities and those without. I remember becoming aware of the emotional and isolating toll these disabilities created for many of my peers, but I was unaware of the physical and chronic pain that could be associated. Working with this client opened my eyes to the impact that massage can truly have on a person’s quality of life. There were moments during the session that I felt overcome with sadness and I also felt overwhelmingly grateful for the people that lovingly support him and for the profession that I have chosen to pursue. Through this 60-minute session, it was reinforced that massage is not just a luxury but a necessity for so many people. Fortunately for this young man, massage is a regular part of his life and he is blessed to have a family committed to loving and supporting him. Yet I know many people do not have access to regular massage. This experience reinforced my belief that massage must become a regular part of treatment for people suffering from disease so that maybe they no longer have to suffer but can instead live with or even overcome the condition.
Resources:
“Chapter 4 Nervous System Conditions.” A Massage Therapist’s Guide to Pathology, by Ruth Werner, 6th ed., Wolters Kluwer, 2016, pp. 220–222.
